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Chapter 24 Coordinating Care for Patients With Infectious Respiratory Disorders
Table 24.2 Approved Influenza Testing Methods for Types A and B
Method
Acceptable Specimens
Test Time
Viral cell culture (conventional)
Nasopharyngeal swab/bronchial wash, throat swab, nasal or endotracheal aspirate, sputum
3–10 days
Rapid cell culture
As above
1–3 days
Immunofluorescence, direct or indirect antibody staining
As above
1–4 hours
RT-PCR
As above
Varied; generally 1–6 hours
Rapid influenza diagnostic tests
Nasopharyngeal swab, throat swab, nasal wash, nasal aspirate
Less than 30 minutes
RT-PCR, Reverse transcription polymerase chain reaction.
avoid dehydration, and rest are typically prescribed. For more serious forms of influenza or widespread local out- breaks, several antiviral medications are available for pro- phylaxis or treatment. The decision to treat flu symptoms utilizing antiviral medications is made on the basis of the severity of the presenting symptoms, such as an illness requiring hospitalization or a severe, complicated ill- ness; the presence of any significant underlying comorbid risk factors; age greater than 65; and pregnancy or recent
postpartum. The administration of antiviral medications does not “cure” the flu; however, further viral replication within the respiratory tract is impaired. This reduces the severity and duration of symptoms and plays a key role in preventing the risk of flu-related complications. The best results are achieved when antiviral medications are initiated within 24 to 48 hours of symptom onset. Antiviral medica- tions are described in Table 24.3. Antibiotic preparations should be reserved for documented bacterial infections.
Table 24.3 Antiviral Medications Used in the Treatment of Influenza
Medication Classification Neuraminidase inhibitors Influenza A/B
Mechanism of Action
Exemplars
Nursing Implications
Zanamivir inhaled (Relenza) Oseltamivir (Tamiflu) Peramivir (Rapivab)
Antiviral treatment should begin within 48 hours of symptom onset. Monitor for: l Onset of worsening respiratory status with underlying airway disease (dyspnea, wheezing, coughing) l Skin reactions (rash, pruritus, urticaria) l Neuropsychiatric events (agitation, delirium, hallucinations) One-time IV dose administration FDA approved for use during pregnancy and breastfeeding (Category C) Monitor for: l Development of angioedema (swelling of the face, lips, and tongue) l Blood in emesis or stool Contraindicated in pregnancy and while breastfeeding. Monitor for: l Onset of new seizures/seizure-like activity, tremors, and gait disturbances. l Neuropsychiatric events l Palpitations or irregular heartbeat Use in pregnancy and breastfeeding not recommended.
Binds to the active site of
neuraminidase protein prevent- ing viral escape from host cell
Endonuclease inhibitor Influenza A/B
Baloxavir (Xofluza)
Inhibits virus cap-dependent endonucle- ase activity preventing viral replication Inhibits uncoat- ing of viral RNA in infected cells, preventing viral replication
RNA synthesis inhibitor Influenza A
Rimantadine (Flumadine)
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